Ultrasound versus computed tomography for the detection of ureteral calculi in the pediatric population: a clinical effectiveness study
Ultrasound versus computed tomography for the detection of ureteral calculi in the pediatric population: a clinical effectiveness study
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DOI：
10.1007/s00261-019-01927-2
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发表时间：
2019-05-01
影响因子：
2.4
通讯作者：
Trout, Andrew T.
中科院分区：
文献类型：
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作者：
Roberson, Nathaniel P.;Dillman, Jonathan R.;Trout, Andrew T.
目的探讨超声对儿童输尿管结石的诊断价值。方法对2012年3月至2017年3月经B超检查确诊为尿路结石的18岁儿童进行临床诊断。排除24小时内无CT平扫的患者(参考标准)。回顾影像(超声和CT)报告，了解结石的存在、数量、大小和位置。结果69例患者中，有38例(55.1%)存在输尿管结石，超声与CT的诊断效果分别是通过直接显影和直接显影结合基于间接超声发现的可疑输尿管结石来计算的。患者平均年龄14.73.6岁，其中35例(51%)为男孩。超声诊断的敏感性为12.8%(95%CI 5.6~26.7%)，特异性为100%(95%CI 96.3~100%)，阳性预测值(PPV)为100%(95%CI 56.6~100%)，阴性预测值(NPV)为74.4%(95%CI 66.4~81.1%)。超声诊断输尿管结石的敏感性为41.0%(95%CI 27.1~56.6%)，特异性为95.0%(95%CI 88.7~97.8%)，PPV为76.2%(95%CI 54.9~89.4%)，NPV为80.3%(95%CI 72.2~86.5%)。尽管当认为可疑检查为阳性时，敏感度会提高。
ObjectiveTo determine the diagnostic performance of ultrasound for diagnosing ureteral calculi in children using a clinical effectiveness approach.MethodsBilling records and imaging reports were used to identify children (18years old) evaluated for suspected urolithiasis using ultrasound between March 2012 and March 2017. Patients without unenhanced CT within 24h (reference standard) were excluded. Imaging (ultrasound and CT) reports were reviewed for presence, number, size, and location of calculi. Diagnostic performance of ultrasound (versus CT) was calculated on an individual ureter basis both by direct calculus visualization as well as direct visualization combined with suspected presence of ureteral stone based on indirect ultrasound findings.Results41 ureteral calculi were present in 38 of 69 (55.1%) patients. Mean patient age was 14.73.6years, and 35 of 69 (51%) patients were boys. Based on direct calculus visualization, ultrasound had a sensitivity of 12.8% (95% CI 5.6-26.7%), specificity of 100% (95% CI 96.3-100%), positive predictive value (PPV) of 100% (95% CI 56.6-100%), and negative predictive value (NPV) of 74.4% (95% CI 66.4-81.1%). When ultrasound examinations reported as suspicious for ureteral calculi based on indirect findings also were considered positive, ultrasound had a sensitivity of 41.0% (95% CI 27.1-56.6%), specificity of 95.0% (95% CI 88.7-97.8%), PPV of 76.2% (95% CI 54.9-89.4%), and NPV of 80.3% (95% CI 72.2-86.5%).Conclusionsp id=ParIn clinical practice, ultrasound has low sensitivity for directly visualizing ureteral calculi subsequently identified by CT, although sensitivity improves when considering suspicious examinations as positive.